激素和非甾体类抗炎药在白内障术后联合使用的临床研究

目的　比较超声乳化白内障吸除术后单纯典必殊眼水 (地塞米松加妥布霉素 )和典必殊减量使用加普南扑灵眼水 (普拉洛芬 )的术后炎症反应 ,以探讨激素和非甾体类抗炎药联合使用在白内障术后应用的价值。方法　采用随机对照的方法 ,将术中无并发症的 12 0只眼分为两组 ,每组 60眼。试验组 :典必殊眼水和普南扑灵合用一周 ,以后普南扑灵单独使用三周。对照组 :典必殊眼水使用四周。分别于术后不同时间观察随访症状、体征、房水闪辉和细胞 ,并测量眼压。结果　两组的术后症状和体征综合得分无显著性差异 (P >0 0 5 ) ;房水闪辉除术后 14天无显著性差异外 (P >0 0 5 ) ,其余均有显著性差异 (P <0 0 5 ) ,试验组比对照组闪辉值低 ;房水细胞在术后 3 0天有统计学差异 (P <0 0 5 ) ,此前 ,两组的前房细胞未见统计学差异 (P >0 0 5 ) ;在术后两周和一月时 ,对照组的眼压比术前有所增加 ,而试验组则轻微降低 ,且有显著性差异 (P <0 0 5 )。结论　无并发症的超声乳化吸除术术后应用激素加非甾体类抗炎药比单纯激素抗炎作用相当甚至更好 ,避免了长期使用激素眼水引起的眼压增高等副作用 ,术后应用非甾体类抗炎药联合激素是一种较好的用药方式

Clinical study of steroids combined with non-steroidal anti-inflammatory drugs (NSAIDs) after cataract surgery

Objective To compare the inflammatory response after phacoemulsification and intraocular lens(IOL)implantation using postoperative treatment with steroids or steroids combined with NSAIDs.Methods A prospective,randomised,controlled study including 120 patients enrolled for cataract surgery.After uneventful phacoemulsification and IOL implantation,the patients were randomised to topical treatment with Tobramycin and dexamethasone(control group)or Tobramycin and dexamethasone combined with pranoprofen(trial group).The inflammatory reaction in the anterior chamber was measured with laser flare meter at 1 day,3 and 7 days,2 and 4 weeks postoperatively.Inflammatory symptoms were registered.Biomicroscopy determinations were performed.Intraocular pressure(IOP)after 2 and 4 weeks was determined.Results After 3 days,7 days and 4 weeks,median flare was lowest in trial group( P <0.05).After 4 weeks,median cell was lowest in trial group( P <0.05).There were no significant differences in inflammatory symptoms and signs between two groups.An increase of IOP was observed in control group after 2 and 4 weeks while a decrease was observed in trial group.Conclusions Dexamethasone with pranoprofen was equally effective,or even better than dexamethasone in relieving postoperative inflammation after uneventful phacoemulsification and IOL implantation in eyes with no other disease than cataract,reducing adverse effects such as IOP elevation of steroids.